Multipurpose void filling prosthesis

ABSTRACT

A void filling prosthesis, which includes first and second ends that define a length therebetween and outer and inner surfaces that define a sidewall therebetween. The sidewall is at least partially curved about an axis that extends along the length of the prosthesis. The prosthesis also includes a fixation prominence extending from the outer surface. The fixation prominence includes a first aperture extending in a direction toward the sidewall and a second aperture extending in a direction transverse to the sidewall.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of the filing date of U.S.Provisional Patent Application No. 62/102,260 filed Jan. 12, 2015, thedisclosure of which is hereby incorporated herein by reference.

BACKGROUND OF THE INVENTION

Joint replacement surgery is a common orthopedic procedure to repair andreplace a damaged, diseased, or otherwise unhealthy joint. Theseprocedures generally fall into two categories: primary and revision. Ina primary joint replacement, the operator replaces the native joint withprosthetic components typically by first resecting the native boneand/or cartilage and then affixing the prosthetic components to theresected bone.

A revision procedure is performed to replace the primary prosthesis, orin some instances, a previously implanted revision prosthesis.Typically, during a revision procedure, the previously implantedprosthesis is extracted and the underlying bone resurfaced inpreparation for receipt of the revision prosthesis. Bone defects in theform of bone loss or deterioration are frequently exposed uponextraction of the previously implanted prosthesis. These defects oftenreside within the epiphyseal and metaphyseal regions of the bone andextend radially outwardly from the center of the bone. Such defects maybe caused by, inter alia, osteolysis, necrosis, infection, and boneincidentally removed along with the previously implanted prosthesis. Inorder to account for such defects, numerous void filling implants, suchas that disclosed in Noiles U.S. Pat. No. 4,846,839, for example, havebeen developed to fill the voids formed by these defects and to providestructural support for the bone and prosthesis.

Despite the benefits of these void filling implants, their use incomplex revision procedures may further complicate the procedure. Priorto extraction of a previously implanted prosthesis, the joint must beexposed. In an example of a total knee replacement, exposure can be madedifficult for a number of reasons, such as an exceptionally tightextensor mechanism, which may be due to an improperly fitted prosthesis.One technique for exposing difficult-to-expose knees is a tibialtubercle osteotomy in which the patella tendon is released from thetibia by resecting the bone surrounding the tibial tubercle, which islater resecured to the tibia by at least one fixation device, such as abone screw or cerclage wire, for example. However, the presence of avoid filler, or even an intramedullary stem, creates an obstacle for thefixation device that must be navigated, oftentimes blind, resulting inincreased complication of the procedure.

In another example, a patient may suffer an extensor mechanismcomplication, such as patellar tendon rupture, that must be repairedduring the revision procedure. The ruptured tendon may be repaired by anallograft technique where a bone plug with an attached tendon is securedto the tibia also by a fixation device. Again the presence of a voidfiller or intramedullary stem may interfere with such a repair.

Therefore there is a need for a void filling prosthesis that facilitatesbone-to-bone fixation and tissue-to-bone fixation.

BRIEF SUMMARY OF THE INVENTION

Generally, disclosed herein are devices and methods for filling bonevoids and also providing means for soft tissue and/or bone-to-bonefixation.

In one aspect of the disclosure, a void filling prosthesis, includesfirst and second ends defining a length therebetween and outer and innersurfaces defining a sidewall therebetween. The sidewall is at leastpartially curved about an axis that extends along the length. The voidfilling prosthesis also includes a fixation prominence extending fromthe outer surface and includes a first aperture extending in a directiontoward the sidewall.

Additionally, the first aperture may be threaded to receive a threadedfastener. A second aperture may define a passageway extending entirelythrough the fixation prominence. Furthermore, a third aperture may bedisposed adjacent to the first aperture. The second aperture may extendthrough the fixation prominence between the first and third apertures.Also, the first and third apertures may extend parallel to each otherand the second aperture may extend substantially perpendicular to thefirst and third apertures.

Continuing with this aspect, the inner surface may include a solidmaterial and the outer surface may include a porous material. Thefixation prominence may be at least partially comprised of a porousmetal material. Also, the void filler may include first and secondportions and a channel extending therethrough. The channel may definethe inner surface. Further, the first and second portions may each besubstantially frustoconical. The void filler may also include at leastone notch in the sidewall. The first portion may be configured to fit ina void formed in a metaphysis of a long bone and the second portion maybe configured to fit in a void formed in a diaphysis of a long bone. Thelong bone may be a tibia. The fit of the first portion in the void maybe a press-fit.

In another aspect of the disclosure, a void filling prosthesis includesfirst and second ends and an inner surface disposed therebetween. Theinner surface defines a channel that extends through the entirety of theprosthesis and is configured to receive an elongate portion of a jointprosthesis therein. The void filling prosthesis also includes a fixationprominence extending from an outer surface of the prosthesis and has atleast one fixation aperture.

Additionally, the at least one fixation aperture may a threaded opening.Also, the channel may extend along a longitudinal axis of the voidfilling prosthesis and the at least one fixation aperture may extendthrough the fixation prominence in a direction transverse to thelongitudinal axis.

Continuing with this aspect, the at least one fixation aperture may be aplurality of fixation apertures that include a first set of fixationapertures that each have a threaded inner surface and a second set offixation apertures that are oriented in a direction transverse to thefirst set of fixation apertures. The first set of fixation apertures mayextend partially into the fixation prominence and the second set offixation apertures extend through the fixation prominence.

In a further aspect of the disclosure, a prosthetic system forimplantation into an end of bone includes a first prosthesis having astem, and a second prosthesis having first and second ends and inner andouter surfaces extending between the first and second ends. The innersurface defines a channel for receipt of the stem. The outer surface hasat least one fixation aperture extending therein.

Additionally, the channel may be configured to receive the stem suchthat a gap sufficiently large to support a cement mantle is formedbetween the stem and the inner surface of the second prosthesis. Thesecond prosthesis may include a first portion configured to be receivedwithin a metaphysis of the bone and a second portion configured to bereceived within a diaphysis of the bone.

Continuing with this aspect, the second prosthesis may include afixation prominence extending radially outwardly therefrom. The at leastone fixation aperture may extend into the fixation prominence. Thefixation prominence may extend along the first and second portions. Thefixation prominence may include an intermediate segment that is at leastpartially cylindrical and the at least one fixation aperture may extendinto the intermediate segment. The at least one fixation aperture may bethreaded. The fixation prominence may include first and second flankingsegments that flank the intermediate segment. The thickness of the voidfiller is may be greater at the intermediate segment than at theflanking segments.

In a still further aspect of the disclosure, a method of implanting avoid filling prosthesis into an end of bone includes inserting a voidfilling prosthesis into a void in the bone. The void filling prosthesishas first and second ends and a fixation prominence extending therefrom.The fixation prominence has at least one fixation aperture. The methodalso includes advancing a first fixation device through the bone and atleast partially into the fixation aperture.

Additionally, the inserting step may include inserting the void fillingprosthesis so that the second end is disposed within the bone and thefirst end is flush with the end of the bone or disposed within the bone.The fixation aperture and fixation device may be correspondinglythreaded. The method may also include reaming a first portion of thebone to receive a first frustoconical portion of the void fillingprosthesis, and reaming a second portion of the bone to receive thefixation prominence. The method may also include inserting a body of anaiming device into the first end of the void filling prosthesis. Theaiming device may include an aiming arm that has at least one guideaperture. The method may also include aligning the at least one guideaperture with at least one fixation aperture.

In yet a further aspect of the disclosure, a method of implanting a voidfilling prosthesis into an end of bone includes inserting a void fillingprosthesis into a void in the bone. The void filling prosthesis hasfirst and second ends and inner and outer surfaces disposedtherebetween. The inner surface defines a channel that extends throughthe entirety of the prosthesis and is configured to receive an elongateportion of a joint prosthesis. The outer surface includes at least onefixation aperture. The method also includes advancing a first fixationdevice through the bone and at least partially into the fixationaperture.

Additionally, the method may also include inserting the elongate portionof a joint prosthesis into and through the channel such that at least aportion of the elongate portion extends from the second end of the voidfilling prosthesis.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying drawings where:

FIG. 1 is a front view of one embodiment of a void filling prosthesis.

FIG. 2 is a perspective view of the void filling prosthesis of FIG. 1.

FIG. 3 is perspective view of one embodiment of a bone resectionassembly.

FIG. 4 is a perspective view of the void filling prosthesis of FIG. 1and an aiming device.

DETAILED DESCRIPTION

When referring to specific directions in the following discussion ofcertain implantable devices, it should be understood that suchdirections are described with regard to the implantable device'sorientation and position during exemplary application to the human body.Thus, as used herein, the term “proximal” means close to the heart andthe term “distal” means more distant from the heart. The term “anterior”means toward the front of the body or the face and the term “posterior”means toward the back of the body. The term “medial” means toward themidline of the body and the term “lateral” means away from the midlineof the body. Also, as used herein, the terms “about,” “generally” and“substantially” are intended to mean that deviations from absolute areincluded within the scope of the term so modified.

FIGS. 1 and 2 depict a void filler 10 or void filling prosthesis that isconfigured for placement within a void in a tibia and generally includesa metaphyseal portion or first portion 12, a diaphyseal portion orsecond portion 14, and a fixation prominence 16 that extends alongportions of metaphyseal and diaphyseal portions 12 and 14. It is notedthat, while the following discussion refers to void filler 10 inrelation to a tibia, the same principles apply for a void filler thatmay be utilized in a proximal humerus or distal or proximal femur. Ofcourse, it is also envisioned that the present invention may haveapplicability elsewhere in the body.

Metaphyseal portion 12, as shown, is generally frustoconical. However,in some embodiments, metaphyseal portion 12 may be cylindrical. In otherembodiments metaphyseal portion 12 may include lobed portions,asymmetrical geometries or other geometries that extend beyond thegeneral frustoconical shape in order to help address asymmetric orlateral and/or medial defects in the bone. Examples of alternategeometrical shapes that can be employed are disclosed in U.S.Publication Nos. 2013/0150858; 2013/0172892; 2014/0276882; and2014/0277567, the disclosures of which are herebyincorporated-by-reference herein in their entireties.

A channel extends through metaphyseal portion 10 and defines an innersurface 26 and a sidewall 30. Inner surface 26 is preferably a steppedsurface or otherwise textured surface to promote bone cement adhesion.Metaphyseal portion 12 also includes notches 28 in sidewall 30 that forma clearance space for a baseplate keel of a tibial component.

Diaphyseal portion 14 is generally cylindrical or frustoconical tosubstantially match the intramedullary canal of a long bone. In someembodiments, diaphyseal portion 14 may be frustoconical with acylindrical distal end. Diaphyseal portion 14 extends distally frommetaphyseal portion 12, and the channel that extends through metaphysealportion 12 also extends through diaphyseal portion 14 so that thechannel extends through the length of the entirety of void filler 10.The inner surface of diaphyseal portion 14 that is defined by thischannel may also be stepped or textured to facilitate cement adhesion.The channel is preferably sized to receive a prosthesis stem and allowfor sufficient space to receive and support a cement mantle such as acement mantle that includes polymethyl methacrylate.

Fixation prominence 16 extends radially outwardly from the outer surfaceof diaphyseal and metaphyseal portions 12 and 14 and extends along theseportions in a general proximal-distal direction. Fixation prominence 16is preferably located in an area of void filler 10 that would be placedin an anterior or posterior position inside a tibial bone. However,fixation prominence 16 can be located in other locations, such as medialor lateral positions on void filler 10. In some embodiments, fixationprominence 16 may only extend along the metaphyseal portion 12 ordiaphyseal portion 14. In other embodiments, there may be multiplefixation prominences 16 extending along void filler 10 in variouslocations. For example, a fixation prominence 16 may extend along voidfiller 10 in an anterior, posterior, lateral, and medial position.

Fixation prominence 16 generally includes an intermediate elongatesegment 18 and flanking elongate segments 20 (best shown in FIG. 1).Intermediate segment 18 protrudes from the outer surface of void filler10 further than at flanking segments 20 such that the thickness of voidfiller 10 at intermediate segment 18 is thicker than at flankingsegments 20. This helps maximize the depth of threaded openings 22extending into intermediate segment 18, while minimizing the amount ofspace taken up by void filler 10 in the bone.

Intermediate and flanking segments 18 and 20 are generally curved toform cylindrical geometries, which may be complementary to a reamingtool. However, in some embodiments flanking segments 20 may blend intointermediate segment 18 to give the appearance of a single segment. Inother, embodiments, segments 18 and 20 may have other geometries, suchas square or triangular geometries. At the distal end of fixationprominence 16, intermediate and flanking segments 18 and 20 are taperedto facilitate impaction into an end of bone.

Fixation prominence 16 includes fixation apertures that may be utilizedto affix bone to bone and tissue to bone via various fixation means,such as threaded fasteners, cerclage wires, and sutures, for example.One such fixation aperture is a threaded opening 22 located inintermediate segment 18. Intermediate segment 18 includes a plurality ofthese threaded openings, which extend in a direction transverse to alongitudinal axis of void filler 10 and toward the sidewall/channel ofvoid filler 10. The depth of threaded openings 22 is such that athreaded fastener, such as a bone screw, can be inserted through asegment of bone and into the threaded portion to create solid fixation.

Another fixation aperture is a passageway 24 that extends throughfixation prominence 16 in a direction transverse to threaded openings22. In some embodiments, the transverse direction may be substantiallyperpendicular with the extent of threaded openings 22. These passagewaysmay be smooth in order to safely house a fixation wire, suture, or otherflexible fixation device. Passageways 24 are generally situated orpositioned through fixation prominence 16 at locations that are betweeneach of the plurality of threaded openings so that threaded openings 22and passageways 24 do not intersect.

While fixation prominence 16 is described and depicted as generallyelongate and extending along and between diaphyseal and metaphysealportions 12 and 14, fixation prominence 16 may be another configuration,including, but not limited to, a plurality of bumps extending outwardlyfrom the sidewall of void filler 10 at various locations about voidfiller 10. Each of these bumps may be square or circular and may eachinclude threaded opening 22 and/or passageway 24 as described above.

Also, it is contemplated that void filler 10 may not include a fixationprominence, but rather threaded openings 22 extending into sidewall 30.In such an embodiment, sidewall 30 may be thicker in order toaccommodate a threaded fastener.

In some embodiments, void filler 10 may be implanted into the bone suchthat fixation prominence 16 faces posteriorly. In such an embodiment,void filler 10 may include circumferential grooves (not shown) withinmetaphyseal and diaphyseal portions 12 and 14 that allow for a wire orsuture to be retained therein, when the wire is wrapped around a portionof void filler 10 from a posterior to anterior direction.

Void filler 10 can be made from any biocompatible material includingstainless steel, titanium, cobalt-chromium, tantalum, niobium, orpolymeric material such as PEEK. In addition, the void filler's bonecontacting surfaces may be made from a porous metal such as titaniumfoam, and the void filler's non-bone contacting surfaces, such as innersurface 26, may be made from solid or nonporous metal. The porosity ofthe bone contacting surfaces allows for bony ingrowth therein. In someembodiments, the entire thickness of void filler 10 may be porous, whilein other embodiments, the entire thickness of void filler 10 may besolid.

With particular regard to the construction of fixation prominence 16,fixation prominence 16 may be entirely porous while the interior ofthreaded apertures 22 and passageways 24 may be coated with a solidmaterial. In some embodiments, threaded openings 22 may be lined with amaterial softer than that of a threaded fastener, which deforms toconform to the threaded fastener upon insertion therein. In otherembodiments, fixation prominence 16 may be primarily solid while theouter surface is treated to provide the requisite porosity. As anexample, such treatment may be performed by high energy beam processing,such as Selective Laser Melting (“SLM”) and Electron Beam Melting(“EBM”), or other additive manufacturing processes. Examples of highenergy beam processing are disclosed in U.S. Pat. Nos. 7,537,664 and8,728,387 and U.S. Publication Nos. 2006/0147332 and 2013/0268085, thedisclosures of which are hereby incorporated-by-reference herein intheir entireties.

FIG. 3 depicts a reamer assembly 100 for preparing a bone to receivevoid filler 10, which includes a trial 130, a reamer guide 120, abushing 140, and a reamer 110. When implanting void filler 10, it ispreferable to have the bone prepared to create a press-fit between voidfiller 10 and the bone such that compression of the bone promotes bonyingrowth into void filler 10. Such bone preparation can be reproduciblyperformed by reamer assembly 100.

Trial 130 includes a head 136 and a shaft 132. Head 136 is frustoconicalto match the profile or shape of metaphyseal portion 12. Head 136includes indicia 138, such as laser lines, to indicate the depth of head136 in the bone. Head 136 also includes a groove 139 extending along itslength to create space for cutting head 112 during the reaming process.

Reamer 110 includes a cutting head 112, a bushing 140, and a depth stop114. Cutting head 112 is slidable within and guided by bushing 140.Depth stop 114 is located proximal to bushing 140 and during usecontacts bushing 140 to indicate that cutting head 112 has reached theappropriate depth.

Reamer guide 120 includes a retaining sleeve 124 that is configured toslide over shaft 132 of trial 130. Reamer guide 120 also includes aguide collar 126 attached to retaining sleeve 124 by a flange 122 suchthat guide collar 126 has a longitudinal axis that is angled withrespect to a longitudinal axis of retaining sleeve 124.

Guide collar 126 generally includes a slot 127 extending through asidewall in guide collar 126. Slot 127 is in communication with aretaining channel that extends through guide collar 126. The retainingchannel is sized to slidingly receive and retain bushing 140, and slot127 is sized to allow reamer head 112, but not bushing 140, to be passedthere through.

Reamer 100 is mounted to guide collar 126 by holding bushing 140 againstdepth stop 114 and passing cutting head 112 though slot 127 and into theretaining channel. Once cutting head 112 is in the retaining channel,bushing 140 is slid into the retaining channel where it is retainedduring the reaming process in which cutting head 112 is guided bybushing 140 into bone.

FIG. 4 depicts an aiming device 200 that can be used when securing athreaded fastener to void filler 10 through bone and/or tissue. Oncevoid filler 10 is implanted, bone and tissue may obscure the operator'sview of fixation apertures 22 and 24. Aiming device 200 allows theoperator to locate threaded openings 22 through such bone and tissue.Aiming device 200 generally includes a body 210 and aiming arm 220.

Body 210 may be cylindrical or frustoconical such that it fits withinthe channel of the metaphyseal portion. Alignment tabs 212 extendradially outwardly from body 210 so that they can engage with or slidewithin notches 28 within void filler 10. This engagement aligns aimingarm 220 with fixation prominence 16.

Aiming arm 220 can be connected to body 210 or in some embodiments maybe integral with body 210, and generally includes a first guide portion222 and a second guide portion 224. First guide 222 portion extends frombody 210 and curves or turns in a distal direction. In one embodiment,first guide portion 222 may include an offset segment (not shown) thatwould be located adjacent to the aiming arm's connection to body 210.The offset segment may be offset laterally or medially to provide aclearance space for the patella and patella tendon during fixation.

First guide portion 222 also includes a plurality of guide apertures 226that are aligned with threaded openings 22 when aiming device 200 isengaged with void filler 10. The second guide portion 224 is offsetanteriorly from first guide portion 222 and also includes a plurality ofguide apertures 226 that are also aligned with threaded openings 22 ofvoid filler 10. This offset relationship helps stabilize a drivingdevice when driving a threaded fastener into threaded opening 22.

In a wire fixation embodiment (not shown), an aiming arm may extend frombody 210 in a lateral or medial direction when engaged to void filler 10and align with passageways 24. In this embodiment, the wires may bepassed through guide apertures in the aiming arm and punched or passedthrough the bone and through passageways 24.

In one embodiment of a method of use, void filler 10 may be utilized toreattach a bone fragment resected during a tibial tubercle osteotomy.Such attachment may be achieved by wire fixation, suture fixation, screwfixation, or the like. In a tibial tubercle osteotomy, a bone fragmentunderlying the tibial tubercle and patella tendon is at least partiallyresected so that the extensor mechanism can be moved aside to expose theprimary or previously implanted prosthesis. The prosthesis is removedfrom the tibia, and the bone is assessed for defects. An appropriatevoid filler is selected based on the size and shape of the defect, and asingle reamer or a series of reamers are used to prepare the void forvoid filler 10. After a generally frustoconical void is formed in themetaphysis with a frustoconical reamer (not shown) that corresponds withhead 136 and metaphyseal portion 12, head 136 of trial 130 may be placedinto the void. If the proper depth of the head, as indicated by indicia138, cannot be reached, the bone is successively reamed until the properdepth is achieved.

Thereafter, with head 136 securely placed within the void such thatgroove 139 generally faces anteriorly, reamer guide 120 is slid overshaft 132 of trial 130 until retaining sleeve 124 abuts abutment surface134. Cutting head 112 is passed through slot 127 while bushing 140 is ina proximal position about cutting head 112 such that bushing 140 isproximal of guide collar 126 as cutting head 112 is passed through slot127. Once cutting head 112 is within the retaining channel of guidecollar 126, bushing 140 is advanced distally until it is fully seatedwithin guide collar 126. Reamer 110 is then advanced into the bone toform a resected geometry to receive fixation prominence 16.

Depending on the condition of the bone and/or the extent of the bonedefect, the tibial tubercle osteotomy may remove so much anterior bonethat a slot in the anterior bone extending into the bone canal isexposed. Where this occurs, anterior reaming for fixation prominence 16may not be warranted since there may be no anterior bone to resect. Ifthis is the case, a rongeur may be used to shape the resected bonefragment to matingly engage fixation prominence 16 when reaffixing thefragment to the tibia.

Once the void has been sufficiently shaped, void filler 10 is insertedinto the bone to achieve a press-fit relationship with the bone viaimpaction or some other means. This impaction or other means may occuruntil the proximal end of void filler 10 is either flush with or belowthe proximal end of the tibia.

Aiming device 200 is then attached to void filler 10 by inserting body210 into metaphyseal portion 12 and by inserting the alignment tabs 212into the notches 28 of metaphyseal portion 12. At this point aiming arm220 is oriented in an anterior position external to the bone and alignedwith fixation prominence 16. The fragment of bone that was removed bythe tibial tubercle osteotomy is placed into a mating position againstthe tibia and a threaded fastener is advanced through guide apertures226 of aiming device 200, through the bone, and into threaded openings22 of void filler 10, thereby affixing the bone fragment to the tibiaand void filler 10.

Once the bone fragment and patella tendon are secured, the tibialprosthesis, which preferably includes a baseplate and a stem, is affixedto the tibia. This may be performed by placing cement or some otheradhesive into the channel of void filler 10 and or around the stem, andthen inserting the stem into and through the channel such that at leasta portion of the stem extends from the distal end of void filler 10.

As an alternative to a threaded fastener, cerclage wires may be utilizedto fix the bone fragment to the tibia. In this embodiment method offixation, an aiming device specific to wire or suture fixation isengaged to the implanted void filler 10. Wires are advanced through theguide apertures, through the bone, through passageways 24, and back outthrough the bone. The free ends of the wires extending from the bone arethen used to affix the bone fragment to the tibia in the usual way.

In another method of wire fixation utilizing void filler 10, void filler10 can be inserted such that fixation prominence 16 faces posteriorly.In this embodiment, wires can be passed through the bone and passageways24 at a posterior region of the tibia and then wrapped around the tibiato secure the bone fragment. Alternatively, the wires may be wrappedaround void filler 10 prior to implantation. This may be achieved byselecting a void filler 10 that is sized to be cemented into the bone,rather than press-fit, or a void filler 10 with channels to house thewires as void filler 10 is impacted into the bone.

Turning to another method embodiment, void filler 10 may be utilized tomake other repairs such as the repair of a ruptured patella tendon. Inthis embodiment void filler 10 is utilized in a similar fashion as witha tibial tubercle osteotomy. For example, where the patella tendon isruptured, a bone plug and tendon allograft may be harvested andimplanted into the tibia. In this embodiment, void filler 10 isimplanted into the bone, aiming device 200 engaged to void filler 10,and the bone plug either fixed to void filler 10 and bone via threadedfastener or via wire fixation, as previously described.

Still other types of procedures are possible utilizing void filler 10described herein. For example, void filler 10 may be used in proceduresinvolving uncontained defects or other bone defects or repairs thatrequire the use of morselized bone graft and metal mesh to contain thebone graft material. In such a procedure, void filler 10 and fixationapertures extending therein may be used to help fix the mesh to voidfiller 10. In this scenario, fixation prominence 16 may be a pluralityof bumps each containing threaded opening 22 or passageway 24 whereinthe bumps and fixation apertures may be utilized to help secure the wiremesh to the bone to facilitate a solid containment unit for themorselized bone graft, particularly as the graft material is beingimpacted into the bone.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

1. A void filling prosthesis, comprising: a body having first and secondends defining a length therebetween and outer and inner surfacesdefining a sidewall therebetween, the sidewall being at least partiallycurved about an axis that extends along the length; and a fixationprominence extending from the outer surface and having a first apertureextending in a direction toward the sidewall.
 2. The void fillingprosthesis of claim 1, wherein the first aperture is threaded to receivea threaded fastener.
 3. The void filling prosthesis of claim 2, furthercomprising a second aperture defining a passageway extending entirelythrough the fixation prominence from one side to another.
 4. The voidfilling prosthesis of claim 3, further comprising a third apertureoffset from the first aperture, and wherein the second aperture extendsthrough the fixation prominence between the first and third apertures.5. The void filling prosthesis of claim 4, wherein the first and thirdapertures extend parallel to each other and the second aperture extendssubstantially perpendicular to the first and third apertures.
 6. Thevoid filler of claim 1, wherein the void filler includes first andsecond portions and a channel extending through the first and secondportions, the channel at least partially defining the inner surface. 7.The void filler of claim 6, wherein the first and second portions areeach substantially frustoconical.
 8. The void filler of claim 6, furthercomprising at least one notch in the sidewall.
 9. The void filler ofclaim 6, wherein the first portion is configured to fit in a void formedin a metaphysis of a long bone and the second portion is configured tofit in a void formed in a diaphysis of a long bone.
 10. A void fillingprosthesis, comprising: first and second ends and an inner surfacedisposed therebetween, the inner surface defining a channel that extendsthrough the entirety of the prosthesis and is configured to receive anelongate portion of a joint prosthesis therein; and a fixationprominence extending from an outer surface of the prosthesis and havingat least one fixation aperture.
 11. The void filling prosthesis of claim10, wherein the at least one fixation aperture is a threaded opening.12. The void filling prosthesis of claim 10, wherein the channel extendsalong a longitudinal axis of the void filling prosthesis and the atleast one fixation aperture extends through the fixation prominence in adirection transverse to the longitudinal axis.
 13. The void fillingprosthesis of claim 10, wherein the at least one fixation aperture is aplurality of fixation apertures that includes a first set of fixationapertures that each have a threaded inner surface and a second set offixation apertures that are oriented in a direction transverse to thefirst set of fixation apertures.
 14. The void filling prosthesis ofclaim 13, wherein the first set of fixation apertures extend partiallyinto the fixation prominence and the second set of fixation aperturesextend through the fixation prominence from one side to another.
 15. Aprosthetic system for implantation into an end of bone, comprising: afirst prosthesis having a stem; and a second prosthesis having first andsecond ends and inner and outer surfaces extending between the first andsecond ends, the inner surface defining a channel for receipt of thestem, the outer surface having at least one fixation aperture extendingtherein.
 16. The system of claim 15, wherein the channel is configuredto receive the stem such that a gap sufficiently large to support acement mantle is formed between the stem and the inner surface of thesecond prosthesis.
 17. The system of claim 15, wherein the secondprosthesis includes a first portion configured to be received within ametaphysis of the bone and a second portion configured to be receivedwithin a diaphysis of the bone.
 18. The system of claim 15, wherein thesecond prosthesis includes a fixation prominence extending radiallyoutwardly therefrom, the at least one fixation aperture extending intothe fixation prominence.
 19. The system of claim 18, wherein thefixation prominence extends along the first and second portions.
 20. Thesystem of claim 19, wherein the fixation prominence includes anintermediate segment that is at least partially cylindrical and the atleast one fixation aperture extends into the intermediate segment.